1980, 11-25 Permit: M80B-4184 Heat Pump(PLAN NUMB °_R
APPLICATION /PERMIT
SPOKANE COUNTY — BUILDING CODES DEPARTMENT
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456 -3675
APPLICANT: COMPLETE NUMBERED SPACES - PRESS HARD TO MAKE 3 COPIES
JOB ADDRESS
LOT
BLOCK
SUBDIVISION
3.
OWNER LV
i —A -d' D1. - •
PHONE
ADDRESS `i
S •
(` (�
CONTRACTOR
ADDRESS
ZIP
PHONE
92,S1zc-z
LEGAL DESCRIPTION - SEE ATTACHED
PARCEL NUMBER /S
Actual Set Backs in Feet
North 'South East 'West
Size of Parcel
Zone Classification
ZIP
I : o `P
DESIGNER
5. ADDRESS
CHANGE OF USE FROM
6.
TYPE
7. OF
WORK
PHONE
ZIP
TO
\NEW ❑ ALT. El AD'N. ❑ RPL. ❑ MVE.
❑ BLD. ❑ PLMB. N, MECH. ❑ M.H. ❑ POOL
DESCRIBE WORK
8. j
VALUATION sOURdE GAS
OF
9. UTILITIES
❑ OTHER
1 I -((
ELECTRIC WATER SEWER
x x
Type Const. I Occupancy
Valuation
Sprinklered
Elves ❑No ❑ Req'd.
Main Floor
Upper Floors
Building Area in Sq. Ft.
Garage Area
Storage
Area of Decks
Finished Basement
Unfin. Basement
No. Baths
No. Stories
No. Rooms
No. of Dwellings
CERTIFICATE
of EXEMPTION
Req'd.
Recd.
Not Req'd.
Enum. Dist.
ILocation (Area)
Ownership
Public ❑ Private ❑
USE CODE
I hereby certify that I have read and examined this application and have read the "NOTICE" provisions included
on reverse side, and know the same to be true and correct. All provisions of laws and ordinances governing this
type of work will be complied with whether specified herein or not. The granting of a permit does not presume
to give authority to violate or cancel the provisions of any other state or local law regulating construction or the
performance of construction. SEE REVERSE SIDE FOR REQUIRED INSPECTIONS
DATE OF APPLICATION I I — 2-,i ` (;)
SIGNATURE OF APPLICANT
SPECIAL APPROVALS
NAME DATE
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
SEPA Checklist
ui g Te 'nicia
SPECIAL CONDITIONS:
PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
FEES COLLECTED
Single $
Building
Plumbing
�o
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
0 a
TOTAL $
PERMIT NUMBER gou
n
04* *9.00
*9,00
*9.006
A *0.00 8
41 8.3z
1 1 -25 -80
6.479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
11j- ,2.55 -8!0
DATE ISSUED
41a4z X900 °a�
PERMIT NO.
0
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1